A recent BMC Medicine study assesses adherence to the World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) recommendations and their impact on cancer incidence in the United Kingdom.
Study: Adherence to the 2018 World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) Cancer Prevention Recommendations and risk of 14 lifestyle-related cancers in the UK Biobank prospective cohort study. Image Credit: Jo Panuwat D / Shutterstock.com
Various lifestyle factors, including physical activity, body composition, and diet, have been associated with the incidence of several types of cancers. In the U.K., about 40% of cancer cases are associated with modifiable risk factors, including obesity, tobacco smoking, alcohol consumption, and insufficient dietary fiber intake.
WCRF/AICR published ten Cancer Prevention Recommendations, which were updated in 2018, based on healthy lifestyle patterns to reduce the risk of cancer and other non-communicable diseases. Although several studies have assessed whether adherence to the WCRF/AICR Cancer Prevention Recommendations influenced cancer incidence and survival rates, most of these studies did not consider the most recent recommendations.
In the latest version, the previous recommendation of less salt consumption has been removed, and a limited intake of sugar-sweetened drinks has been included. In addition, a previous recommendation published in 2007 recommended a minimum consumption of 25 grams of dietary fiber daily, which was increased to at least 30 grams daily in the 2018 version.
A meta-analysis and systematic review documented significant adherence to the 2007 Cancer Prevention Recommendations that reduced the risk of colorectal, lung, and breast cancer. Greater adherence to the recommendations also reduced the overall cancer-specific mortality.
Importantly, different approaches were used to calculate adherence to the recommendations, which resulted in differential assessment outcomes. Therefore, there is a need for a standardized assessment to offer consistency and comparability between studies.
In this context, Shams-White and colleagues developed a standardized scoring system in 2019 that operationalized seven of the ten recommendations. However, few studies have used this system to assess adherence to the 2018 Cancer Prevention Recommendations.
About the study
The current U.K. Biobank prospective cohort study evaluated the association between adherence to 2018 WCRF/AICR Cancer Prevention Recommendations using a standardized fully operationalizing score and the risk of multiple cancers. To this end, the researchers assessed how diet, nutrition, and physical activity influenced the risk of all forms of invasive cancers, as well as fourteen specific cancers, including those affecting the uterus, bladder, gallbladder, colorectal, kidney, head and neck, breast, lungs, prostate, pancreas, esophagus, stomach, liver, and, ovaries.
The study cohort included over 500,000 participants recruited from 22 centers across England, Wales, and Scotland between 2006 and 2010. The U.K. Biobank cohort included participants between the ages of 37 and 73 years, about 56% female.
A total of 94,778 UK Biobank participants were selected for the current study. During a median follow-up after 7.9 years, 7,296 participants were diagnosed with cancer, the most common of which was prostate, followed by breast and colorectal cancers.
A significant inverse correlation was observed between the total adherence score and the risk of all cancers. A 7% reduction in cancer risk was observed on every one-point increment in the score, which was adjusted for age, ethnicity, sex, smoking status, and deprivation.
Individuals with 3.75-4.25 point and 4.5–7 point score tertiles exhibited an 8% and 16% lower risk of developing all types of cancers, respectively. Likewise, one Swedish study indicated a 3% reduction in cancer risk for every one-point increment in score. These differential reduction values indicate the need to determine associations using the global population.
The current study estimated a 10% reduction in the risk of breast cancer on every one-point increment in adherence score. Individuals whose adherence score was between 5.75-7 points were at the lowest risk of breast cancer incidence.
A 10% reduction in incidence risk for colorectal cancer was observed for every one-point increment in score. For this type of cancer, participants belonging to the middle and highest score tertiles were at a lower risk of cancer incidence.
Greater adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations reduced the risk of esophageal, kidney, gallbladder, ovarian, and liver cancers. Consistent with the current study findings, a previous EPIC Study similarly indicated a 42% reduced risk of esophageal, kidney, and liver cancers following the 2007 version of the WCRF/AICR Cancer Prevention Recommendations.
The current study revealed that greater adherence to the 2018 version of WCRF/AICR Cancer Prevention Recommendations reduced the risk of different types of cancers, including ovarian, breast, kidney, gallbladder, colorectal, oesophageal, and liver cancers. These findings strongly support the 2018 WCRF/AICR Cancer Prevention Recommendations to prevent/reduce cancer incidence in the U.K.
In the future, similar studies should be conducted to assess the effectiveness of the recommendations on other global populations. However, these types of studies must incorporate a standardized methodology to enable comparability across studies.
- Malcomson, F. C., Parra-Soto, S., Ho, F. K., et al. (2023) Adherence to the 2018 World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) Cancer Prevention Recommendations and risk of 14 lifestyle-related cancers in the UK Biobank prospective cohort study. BMC Medicine 21(407). doi:10.1186/s12916-023-03107-y